Rumination Syndrome Research Articles

Rumination, Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

ABSTRACTThis study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.

Oral health status in children with intellectual disability living in organized groups

The aim of the study was to assess oral health status in in children with intellectual disability (ID) living in Moscow Orphanage №15. The study involved 91 children aged 12 (39 children) and 15 (52 children). Caries incidence and DMFT index, periodontal disease incidence, OHI-S and PMA index, malocclusions incidence were assessed at baseline examination. Caries incidence in 12 and 15 y.o. was moderate (53.85% and 56.0%, correspondingly), as well as DMFT (2.77±0.52 и 2.94±0.53 correspondingly). In 2 children with rumination syndrome all teeth were affected by caries and these children received dental treatment under general anesthesia 7 times during last 60 months. Periodontal disease incidence in 12 and 15 y.o. was 89.74% и 86.58%, correspondingly with very high OHI-S indicating unsatisfactory oral hygiene. Malocclusions incidence was 95% and 98%, correspondingly. Thus the main oral problem in children with ID is periodontal disease and poor oral hygiene. Differentiated oral hygiene education approach according to children's physical and intellectual abilities should be considered. Children with rumination syndrome should be addressed by neurologist prior to dental treatment which needs more radical approach.

Nonspecific eating disorders - a subjective review.

The aim of this paper was to characterise nonspecific eating disorders (other than anorexia nervosa and bulimia nervosa). The Medline database was searched for articles on nonspecific eating disorders. The following disorders were described: binge eating disorder (BED), pica, rumination disorder, avoidant/restrictive food intake disorder, night eating syndrome (NES), sleep-related eating disorder (SRED), bigorexia, orthorexia, focusing on diagnosis, symptoms, assessment, comorbidities, clinical implications and treatment. All of the included disorders may have dangerous consequences, both somatic and psychological. They are often comorbid with other psychiatric disorders. Approximately a few percent of general population can be diagnosed with each disorder, from 0.5-4.7% (SRED) to about 7% (orthorexia). With the growing literature on the subject and changes in DSM-5, clinicians recognise and treat those disorders more often. More studies have to be conducted in order to differentiate disorders and treat or prevent them appropriately.

Estudio epidemiológico de paratuberculosis bovina en hatos lecheros del sur de Nariño, Colombia

Introducción: la paratuberculosis (PTBC), también llamada enfermedad de Johne, es un trastorno gastrointestinal crónico de rumiantes domésticos y silvestres causado por Micobacterium avium subespecie paratuberculosis (MAP). Está distribuida mundialmente y genera un alto impacto en la ganadería, debido a que disminuye la producción, se pierde potencial genético por reemplazos tempranos de animales infectados y se incrementa la mortalidad. Objetivos: evaluar la presencia de anticuerpos anti-MAP en fincas lecheras del sur de Nariño y describir su distribución de acuerdo con características poblacionales. Métodos: se realizó un estudio transversal descriptivo en 958 vacas mayores de 2 años en 16 fincas lecheras. Para determinar la presencia de anticuerpos, se usó la prueba diagnóstica de Elisa indirecto (kit comercial Svanova®). La seropositividad fue asociada con las variables de raza, edad, ubicación, condición corporal, número de lactancias y estadio clínico mediante la prueba estadística de chi cuadrado. Resultados: se encontraron 15 fincas (94 %) con al menos un animal positivo y 77 vacas (8 %) con anticuerpos anti-MAP. Se estableció una asociación significativa (p < 0,05) con la condición corporal del animal. Conclusiones: en los principales municipios lecheros se encontraron vacas con anticuerpos anti-MAP y no se encontró relación entre edad, raza, ubicación y estatus clínico con la seroprevalencia-MAP, pero sí con la condición corporal.

Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action.

While high resolution esophageal manometry combined with impedancometry has demonstrated that gastric pressurizations lead to rumination, the contribution of upper esophageal sphincter (UES) and esophagogastric junction (EGJ) function to rumination is unclear. Behavioral therapy with diaphragmatic breathing (DB) can reduce rumination. We aimed to evaluate the pressures in the stomach, EGJ and UES during rumination and the effects of DB augmented with biofeedback therapy. Sixteen patients with rumination were studied with manometry and impedancometry before and after a meal. The postprandial assessment comprised three periods: before, during, and after DB augmented with biofeedback therapy. All patients had postprandial rumination, which was associated (p < 0.001) with increased gastric pressure and reversal of the postprandial gastroesophageal pressure gradient from -4 (-43 to 18) before to 20 (7-79) mmHg during rumination. The EGJ pressure was lower (p < 0.001) during gastric pressurizations that were associated with rumination vs those that were not. The UES also relaxed, almost completely, during rumination. Patients had a median (range) of 5 (2-10) rumination episodes before, 1 (0-2) (p < 0.001) during, and 3 (1-5) after (p < 0.001 vs during) diaphragmatic breathing. During manometry and impedancometry, DB was well-tolerated and learned within 5 min. Diaphragmatic breathing increased EGJ pressure (p < 0.001) and restored a negative gastroesophageal pressure gradient (-20 mmHg [-80 to 7]). Diaphragmatic breathing aided with high resolution esophageal manometry is well-tolerated, effective and averts the gastroesophageal pressure disturbance that leads to rumination.

Inpatient treatment of rumination syndrome: Outcomes and lessons learned.

Inpatient treatment of rumination syndrome: Outcomes and lessons learned.

Recent Advances in BLV Research.

Different animal models have been proposed to investigate the mechanisms of Human T-lymphotropic Virus (HTLV)-induced pathogenesis: rats, transgenic and NOD-SCID/γcnull (NOG) mice, rabbits, squirrel monkeys, baboons and macaques. These systems indeed provide useful information but have intrinsic limitations such as lack of disease relevance, species specificity or inadequate immune response. Another strategy based on a comparative virology approach is to characterize a related pathogen and to speculate on possible shared mechanisms. In this perspective, bovine leukemia virus (BLV), another member of the deltaretrovirus genus, is evolutionary related to HTLV-1. BLV induces lymphoproliferative disorders in ruminants providing useful information on the mechanisms of viral persistence, genetic determinants of pathogenesis and potential novel therapies.

Prevalence of different reproductive disorders of small ruminants in five upazillas of Mymensingh district

Small ruminants (goat and sheep) are economically important and promising animal resource in Bangladesh. Reproductive disorders of goat and sheep cause the great economic problems. Therefore, the aim of the study was to investigate the prevalence of reproductive disorders in goat and sheep in five upazillas of Mymensingh district. Records of reproductive disorders were collected from official stock book of different Upazillas veterinary hospitals of Mymensingh district during April 2010 to March 2011. Seasonal occurrences of reproductive disorders were also recorded. Descriptive statistical analysis was done to study the prevalence of different reproductive disorders of goat and sheep in five upazillas of Mymensingh district. Out of 4804 clinical cases, a total of 147 reproductive disorders of goat and sheep were screened out from datasheet of official stock book. Among the five upazila, the prevalence of reproductive disorders was higher in Muktagacha (3.35%) and lower in Fulbaria (2.38%). Prevalence of reproductive disorders in all upazila was higher in sheep (4.12%) than goat (2.88%). Prevalence of reproductive disorders of goat was higher in Tarakanda (3.26%) and lower in Fulbaria (2.03%) and the prevalence of reproductive disorders of sheep was higher in Gaforgaon (5.22%) and lower in Haluaghat (3.15%). The major reproductive disorders recorded in goats were dystocia (41.2%), abortion (21.8%), mastitis (21.8%), retained placenta (11.8%) and pyometra (3.4%). Similarly, major reproductive disorders in sheep were dystocia (53.7%), abortion (25%), pyometra (7.1%), mastitis (7.1%) and retained placenta (7.1%). Moreover, seasonal prevalence of reproductive disorders was higher in summer than winter in the species, goat (57.14%) and sheep (12.25%). It was concluded that the most pressing constraint on goat and sheep reproduction in Bangladesh is dystocia, abortion and mastitis. Strategies should be taken to minimize their occurrence.Asian J. Med. Biol. Res. June 2015, 1(1): 74-79

Is Nissen Fundoplication Surgery Efficacious for the Treatment of Food Reflux or Regurgitation? A Mayo Clinic Study

Introduction: Rumination is characterized by frequent effortless regurgitation of recently ingested food, followed by expulsion or re-swallowing. Rumination syndrome may be misdiagnosed as refractory gastroesophageal reflux disorder leading to Nissen fundoplication; the outcome in rumination syndrome is unclear. Aims: To evaluate the outcomes of Nissen fundoplication in the treatment of rumination syndrome and describe outcomes of behavioral therapy after Nissen fundoplication. Methods: We conducted a cross-sectional study by reviewing medical records of patients diagnosed with rumination syndrome from 1995 to 2015 who had undergone Nissen fundoplication elsewhere, prior to the diagnosis at Mayo Clinic. Twelve patients, aged 23-65y, were invited to participate in a questionnaire survey. The variables studied included age, sex, race, duration of symptoms, associated symptoms, initial upper GI symptoms, upper GI symptoms after Nissen fundoplication, investigations, and management. Results: Among the 12 patients, 10 were female, age at diagnosis was 32.3+13.8y (SD), and duration of symptoms before diagnosis was 9.8+9.9y. Seven patients (58.3%) were receiving psychiatric medications. Initial symptoms were: regurgitation (4/12), acid reflux (3/12), both regurgitation and acid reflux (2/12), vomiting in 3/12. Symptoms recurred within 3 months of the Nissen fundoplication in 7/12, and within 1.5-6 years in 3/12 patients. Two patients reported 40% and 70% improvement in their symptoms after Nissen fundoplication; in contrast, severity of upper GI symptoms increased in 9/12 patients. Before the diagnosis of rumination syndrome, Nissen procedure was redone in 2/12, revised in 3/12, and taken down in 3/12. Three of the 12 patients required tube feeding (1 each nasogastric, gastric, jejunal) after Nissen fundoplication, and 4/12 required multiple esophageal dilatations. After the diagnosis of rumination syndrome, all patients underwent behavioral therapy and were taught to perform diaphragmatic breathing during and after meal ingestion. Eight patients consented to participate in a follow-up questionnaire at least 6 months after this therapy; behavioral therapy helped control regurgitation symptoms >80% of the times in 4/8, 60-80% of the times in 1/8, and < 20% in 3/8 patients. Conclusion: Behavioral therapy with diaphragmatic breathing may be efficacious in controlling regurgitation associated with rumination syndrome after Nissen fundoplication.

OP‐23 FUNCTIONAL DYSPEPSIA IS ASSOCIATED WITH DUODENAL EOSINOPHILIA IN A PEDIATRIC COHORT

Objectives:Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder with unknown etiology. We aimed to assess the association between dyspeptic symptoms and duodenal eosinophilia in children referred for upper endoscopy.Methods:In this retrospective cohort study, all histopathology reports of normal upper endoscopies performed at a single tertiary center between 2010 and 2014 were reviewed. FD was defined as epigastric pain or discomfort for more than 2 months with no response to acid suppressants. Controls were those with non‐erosive reflux disease, dysphagia or rumination syndrome. Duodenal biopsies were analyzed by pathologists blinded to indication. Intramucosal eosinophils were counted per mm2 on haematoxylin and eosin stained digital imaged sections using Aperio eSlide Manager. Demographics, clinical variables, family history and histologic findings were compared between cases and controls.Results:In total, 36 cases and 36 non‐matched controls were identified of which 56% and 53% were female (p = 0.81). Mean (± SD) age was higher in cases compared to controls (13.6 (± 3.1) vs. 10.5 (± 4.0) years; p = .001). Dyspeptic symptoms (epigastric pain 81% and/or upper abdominal discomfort 33%) were food‐related in 69% and nocturnal in 31% of cases. Self‐reported nausea (64% vs. 17%; p &lt; .0001), lethargy (19% vs. 0%; p = .005) and a family history of functional gastrointestinal disorders (28% vs. 3%; p = .003) were more common in cases than controls. There was a higher but not significantly different rate of atopic history (39% vs. 25%; p = .21) and psychological co‐morbidity (53% vs. 39%; p = .24) in FD cases versus controls. Duodenal intraepithelial lymphocytes per 100 enterocytes were similar in cases and controls (median (IQR) 10 (8–13) vs. 12 (8–18); p = 0.12). Duodenal eosinophil counts per mm2 were significantly increased in cases compared to controls (151 (118–207) vs. 76 (60–106); p &lt; 0.001).Conclusions:This study confirms recent reports of duodenal eosinophilia in FD. The high rate of atopic and psychological co‐morbidity in FD suggests multi‐factorial mechanisms and may explain why current therapeutic options aimed at symptom control are largely unsatisfactory. Duodenal eosinophilia in FD should be considered a therapeutic target.

Fecal Microbiota Transplantation: Harnessing the Gut Microbiota to Treat Disease

Fecal microbiota transplantation (FMT) involves the transfer of consortia of bacteria from healthy individuals to patients with Clostridium difficile infection (CDI) or other conditions to promote recolonization with missing components of intestinal flora. FMT dates as far back as 4th-century China when human fecal suspensions were used to treat food poisoning and severe diarrhea and has been used in veterinary medicine to treat ruminal disorders at least as far back as the 17th century.

Tu1445 High Resolution Esophageal Manometry Pattern in Children and Adolescents With Rumination Syndrome

Tu1445 High Resolution Esophageal Manometry Pattern in Children and Adolescents With Rumination Syndrome

Microbiome-metabolome analysis reveals unhealthy alterations in the composition and metabolism of ruminal microbiota with increasing dietary grain in a goat model.

Currently, knowledge about the impact of high-grain (HG) feeding on rumen microbiota and metabolome is limited. In this study, a combination of the 454 pyrosequencing strategy and the mass spectrometry-based metabolomics technique was applied to investigate the effects of increased dietary grain (0%, 25% and 50% maize grain) on changes in whole ruminal microbiota and their metabolites using goat as a ruminant model. We observed a significant influence of HG feeding in shaping the ruminal bacterial community structure, diversity and composition, with an overall dominance of bacteria of the phylum Firmicutes along with a low abundance of Bacteriodetes in the HG group. High-grain feeding increased the number of ciliate and methanogens, and decreased the density of anaerobic fungi and the richness of the archaeal community. The metabolomics analysis revealed that HG feeding increased the levels of several toxic, inflammatory and unnatural compounds, including endotoxin, tryptamine, tyramine, histamine and phenylacetate. Correlation analysis on the combined datasets revealed some potential relationships between ruminal metabolites and certain microbial species. Information about these relationships may prove useful in either direct (therapeutic) or indirect (dietary) interventions for ruminal disorders due to microbial compositional shifts, such as ruminal acidosis.

Clinical and Rumen Fluid Evaluation of Ruminal Disorders in Cattle

Clinical and rumen fluid changes in various ruminal disorders were studied clinically in 13 cattle at University of Gondar veterinary clinic, Gondar town, Ethiopia from September 2013 to May 2014. History, clinical signs, physiological and rumen fluid parameters were studied in all the cattle. The comparisons of the means between different stages of physiological parameters of different ruminal disorders were determined by repeated measure ANOVA to evaluate pre and post rumenotomy changes. The predominant clinical observations were, abdominal distension in non potential foreign bodies; grunt with bruxism in potential foreign bodies; bloat along with colic signs in ruminal tympany; and fluid splashing sound with palpable mass in the rumen in ruminal impaction. Poor quality roughage and excess concentrate were found to be the predisposing factors in ruminal disorders. In physiological parameters significant increase in temperature and decrease in rumen motility from the presurgical values up to 24 hrs and 48 hrs after rumenotomy were observed. Heart, pulse and respiratory rates revealed none significant changes between pre and post surgical intervals. The rumen fluid of cattle with different ruminal disorders on analysis before rumenotomy showed brownish colour, watery consistency, aromatic odour, pH range 4.9–8.0, increased MBRT and sedimentation activity time in most of the cases.

Current Advances in surgical Management of Ruminal Disorders of Bovine

Ruminal disorders in ruminant are numerous and constitute a major clinical problem. Disorders of forestomach in adult cattle can result from a variety of common causes including traumatic reticulo-peritonitis, ruminal acidosis, bloat, simple indigestion and vagal indigestion. The bovine forestomach are affected highly due to ingested foreign bodies which are the subject of attention almost all over the world and also major economic importance due to severe loss of production and productivity and sometimes death of the animal. The animals are stabilized with fluids and electrolytes for the imbalances preoperatively. Preparation of the animal for surgery includes removal of the hair and cleansing of the skin around the surgical site. Rumenotomy and diaphragmatic hernia repair are surgeries performed for treating many ruminal disorders in bovine. Anaesthetic techniques required for rumenotomy are para-vertebral nerve block by use of lignocaine hydrochloride. Ultrasound diagnosis, completely siphon out of the fluid, visceral blockade and refilling of rumen with refilling agents are among the current advances in surgical managements of ruminal disorders. A long vertical skin incision starting about three to four centimeters below the transverse process of the lumbar vertebrae is made. The abdominal muscles and peritoneum are also incised corresponding to the skin incision. The rumen incision is closed by double row of continuous inverting sutures using chromic catgut. The commonest complications are wound dehiscence and hemorrhage and seroma formation.

Effects of physically effective neutral detergent fibre content on dry-matter intake, digestibility and chewing activity in beef cattle fed total mixed ration

Our aim in this study was to determine the effects of physically effective neutral detergent fibre (peNDF) in a total mixed ration (TMR) on feed intake, digestibility and chewing activity in beef cattle. The experiment had a replicated 3 × 3 Latin square desig, using three fattening Hanwoo (Bos taurus coreanae) steers with ruminal cannulas. Steers were offered one of three diets (high, medium or low peNDF content) obtained by mixing the same TMR for different periods of time (5, 13 and 25 min). peNDF content of TMR was calculated as [total chewing time/NDF intake (kg)] × dietary NDF content, and the proportion of sample dry matter (DM) collected in a ≥1.18-mm sieve is commonly used as the physical effectiveness factor in the equation. The peNDF1.18 contents of the high, medium and low diets were 25.97%, 21.10% and 17.94% (P &lt; 0.05). In addition, the proportion of particles collected on the 19-mm, 1.18-mm, and pan sieves changed linearly with an increase of TMR mixing time. Mean particle-size distributions of diets were 11.43, 24.11, 30.70 and 33.68 for 19 mm, 8 mm, 1.18 mm and pan, respectively. Eating rate and ruminating and chewing efficiencies were significantly decreased with reduced peNDF content, and DM intake was increased significantly (P &lt; 0.05). Lower peNDF content reduced the total number of chews significantly (P &lt; 0.05). Total time spent chewing associated with eating was not affected by peNDF contents. Digestibility of DM, crude protein and crude fat decreased with reducing peNDF content in the diet, but there was no significant difference among the three groups. These results indicated that peNDF affects intake, digestibility and chewing activity in beef cattle. Therefore, high levels of peNDF appears to improve TMR, as it can increase efficiency and may prevent ruminal disorders in Hanwoo steer.

Detection and genotyping of Chlamydia species responsible for reproductive disorders in Algerian small ruminants.

Chlamydiosis in small ruminants is a zoonotic disease mainly related to Chlamydia abortus. This bacterium is responsible for abortions and reproductive disorders in sheep and goats. Stillbirth and infertility, leading to important economic losses, are also associated with this pathology. In Algeria, abortion cases are frequently reported by veterinarians but, except for brucellosis which is a notifiable disease in this country, abortive diseases are in general poorly studied. In order to detect and genotype Chlamydia species in small ruminants in different areas of Algeria, a study was conducted on samples collected from females (164 blood samples and 199 vaginal swabs) between October 2011 and March 2013. Serum samples were tested with a C. abortus-specific indirect ELISA test. Fourteen samples (8.5%), from six farms (6/20, 30%) were tested positive. Vaginal swabs were analysed with a real-time PCR targeting all Chlamydiaceae spp. Thirty samples (15%) were diagnosed positive in 16 farms (16/25, 64%). Positive samples were all re-tested with a C. abortus- and a C. pecorum-specific real-time PCR. Finally, 13/30 (43.3%) and 6/30 (20%) were identified as C. abortus and C. pecorum, respectively. Enough concentrated C. abortus samples were genotyped by multi-loci variable number of tandem repeat (VNTR) analysis (MLVA), and all were related to the genotype [2] group which mainly includes French C. abortus isolates. C. pecorum-positive samples were genotyped by multi-locus sequence typing (MLST). Interestingly, two of them were successfully genotyped and showed identical MLST sequences to VB2, AB10, E58 and SBE, a group which includes C. pecorum isolates considered as highly pathogenic. These findings suggest a possible role of C. abortus and C. pecorum strains in the aetiology of abortion in Algerian small ruminants.

Rumination Syndrome: A Review of Current Concepts and Treatments

Rumination is a normal and common phenomenon among ruminant animals; but in humans, it is always regarded as symptom indicative of abnormal function of the upper gastrointestinal tract, and understanding of the mechanisms explaining this event are still evolving. Learning-based theories, organic factors such as gastroesophageal reflux disease and psychological disturbances (eg, depression, anxiety) and the role of life stresses have been postulated as potential mechanisms of rumination. in this review, we take the approach that rumination syndrome is a distinct and discrete functional gastroduodenal disorder. we review current concepts of the pathophysiology of this entity and diagnostic approaches, then detail the treatment paradigms that have been pursued in rumination syndrome in adults. Patients with rumination syndrome have a very distinct set of symptoms. it was focused on the immediate postprandial period, but recently, there is an awareness of an expanding spectrum of the clinical presentation. This includes the concept of "conditioned vomiting" occurring in the setting of delayed gastric emptying (gastroparesis). Physicians' awareness of rumination syndrome is essential in the diagnosis and management of this disorder. Stress and psychological aspects in rumination syndrome are invariably in the background and have to be addressed. The crucial steps in the treatment strategy for rumination syndrome rely on reassurance, education and a physiologic explanation to the patient and family that this is not a "disease," followed by behavioral and relaxation programs and addressing stress factors.

Rumination syndrome in ethiopia: a case study.

Eating disorders are commonly believed to be rare or nonexistent in Africa. However, due to exposure to Western culture, a rise in eating disorders among African women is reported in the literature. This case study describes a 17-year-old Ethiopian girl who meets the DSM-IV-TR and DSM-5 diagnostic criteria for bulimia nervosa and the Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders criteria for rumination syndrome. The article discusses the diagnostic delays, the difficulties in terms of therapy, and the context determinants that-combined with individual psychopathological features-are thought to contribute to the disorders. Health professionals should be informed about the prevalence of eating disorders in Africa and, more specifically, of rumination syndrome in young women with normal intelligence. In light of this case study, it seems necessary to raise awareness with regard to the insufficient evidence on effective therapies for rumination syndrome in individuals without intellectual impairment.

Adolescent rumination syndrome.

Rumination syndrome is the non-purposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or reswallowed. Adolescent rumination syndrome (ARS) is a rare condition of which many physicians are unaware. Patients often are misdiagnosed or undergo costly testing, and as a result, diagnosis and treatment are often delayed. While ARS is not life-threatening, it does have medical and emotional effects on the patient and the patient's family. Diagnosis of ARS is based upon the Rome III diagnostic criteria. Antroduodenal manometry, while not required for a diagnosis, can be helpful to confirm the diagnosis. The pathogenesis of this disorder is complex and not well understood. However, because of its behavioral component, treatment of ARS requires a multidisciplinary approach that includes both medical management of symptoms and implementation of strategies that address behavioral, psychological, and general quality-of-life components of the disorder.